Cases reported "Leg Length Inequality"

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1/4. Lengthening of replanted or revascularized lower limbs: is length discrepancy a contraindication for limb salvage?

    Some replantation cases require substantial bone shortening for primary closure. leg-length discrepancy can be restored by lengthening of the replanted or revascularized extremities. Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations had replantation or revascularization for their severely damaged extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities failed and had to undergo below-knee amputation because of sepsis. No other infection or vascular complications were encountered following the replantations or revascularizations. After bony consolidation, four legs were lengthened; for elimination of length discrepancy in three cases, and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all procedures, a unilateral dynamic axial external fixator was used. The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score (MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity, because of the required debridement of soft tissue and bone. These authors think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motion and the possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage, even with deliberate shortening that can be restored by lengthening; length discrepancy is not a contraindication for limb salvage.
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ranking = 1
keywords = vascular complication
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2/4. Vascular complications in orthopaedic patients treated by orthopaedic microsurgeons.

    Over a 20 year period, five patients experienced serious vascular complications involving major arterial insult during various routine orthopaedic procedures. The nature of the vascular damage necessitated immediate surgical repair which was performed successfully by an orthopaedic microsurgeon who was either a member of the initial surgical team or the hospital's Orthopaedic Unit. The purpose of this study is to illustrate not only the severity of these limb and/or life-threatening complications, but also to focus attention on the importance of the orthopaedic surgeon's ability to manage these serious injuries promptly. This suggests the need for Orthopaedic Units to have surgeons with adequate training in microvascular techniques, so as to be able to successfully manage these unexpected and serious complications. We conclude that the presence of a vascular surgeon or an orthopaedic surgeon trained in microvascular surgery represents an invaluable attribute to the orthopaedic team, and minimizes, if not eliminates the potentially disastrous outcome from these serious intraoperative vascular complications.
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ranking = 2
keywords = vascular complication
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3/4. Thermal asymmetry of the upper extremity in scalenus anticus syndrome, leg-length inequality and response to chiropractic adjustment.

    OBJECTIVE: To describe a case of a vasomotor, vascular form of thoracic outlet syndrome that causes upper extremity thermal asymmetry, and to discuss a single subject case study (N-of-1) comparing the correlation of a subjective test for putative atlas vertebral subluxation complex (supine leg-length inequality) with a single blinded objective measurement [temperature differential (delta degree T)] on the dorsum of the hands. CLINICAL FEATURES: A 71-yr-old woman with a cold, painful right hand and chronic neck pain sought chiropractic evaluation. There was a left head tilt and muscular hypertonicity with fibrous bands in the opposite scalenes and sternocleidomastoid. Thermographic examination revealed a large temperature differential (12 degrees F) between the dorsum of the right and left hands, with the superficial veins on the dorsum of the cold hand collapsed. Thoracic outlet provocation tests were negative. A left-side leg-length inequality potentially indicative of putative upper cervical subluxation was also noted. A diagnosis of presumptive thoracic outlet syndrome with vasomotor vascular complications subsequent to altered cervical biomechanics was made. INTERVENTION AND OUTCOME: Treatment was limited to chiropractic, upper cervical, vectored, linear adjustment of the atlas vertebra. temperature differential between the hands improved significantly after individual atlas adjustment(s) and in the long term. CONCLUSION: Scalenus anticus syndrome and upper extremity thermal asymmetry may result from altered cervical biomechanics caused by atlas vertebral subluxation complex. Furthermore, the supine leg check may be of value in determining the necessity of atlas adjustment.
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ranking = 1
keywords = vascular complication
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4/4. melorheostosis: complications of a tibial lengthening with the Ilizarov apparatus.

    melorheostosis is a rare bone dysplasia, exceptionally described in childhood. It has been discovered in a 12-year-old boy who had a hemimelic affection associated with straw-berry skin marks. A 25 mm inequality of length of the lower limbs and a valgus deformation of the ankle resulting in a claudication and gonalgia requiring surgical correction. A reaxation and a progressive lengthening with the Ilizarov apparatus has been performed. Non-consolidation and a secondary bone infection led to the necessity of formation of a soleus flap. Consolidation and healing were finally obtained. In addition to vascular complications to be feared in this disease during surgical treatment, we have to take into consideration the absence of consolidation when the osteotomy is not performed on a safe bone.
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ranking = 1
keywords = vascular complication
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